Getting hospital data to connect to the NHS 'spine'

Birmingham university hospital knows who I am. Even though I've never been there before, the ward terminal throws up my NHS "demographic details", including my 10-digit patient identity number, within a couple of seconds of having my name and date of birth. In an age when we can receive mobile phone calls and draw cash from bank machines anywhere in the world, the real-time linking of a hospital administration system to a central register of patients may not impress.

For the NHS in England, however, it is a triumph, an important step in its gruelling multibillion-pound IT project. Unless hospitals can be certain that the information recorded by doctors and nurses applies to a unique patient, the government's vision of electronic health records accessible from anywhere in the NHS is a castle in the air.

Hence the huge effort being put into replacing hospital systems with IT that can connect to the new nationwideNational Health Service "spine". Until last week, the West Midlands was the exemplar in building this new infrastructure, which is why I was invited to see it in action at University Hospital Birmingham Trust, one of the country's biggest and most complex hospitals. (The Department of Health even tried to send a press officer along to host my tour; I declined.)

For reasons I'll come to, West Midlands is no longer such a shining example. But the university hospital has done an excellent job in replacing an obsolete mainframe with national standard spine-compliant systems. Even though the new system is not yet carrying clinical data, the IT director, Andrew Haw, says it is dramatically improving the process of care and the hospital's ability to manage resources.

The big change is in the integrity of data. In the old days, there was nothing to stop the patient administration system creating multiple identities for the same individual. When it changed to the new system, the hospital found 30,000 duplicates among 750,000 records on its master-patient index.

With the new system, all records are matched in real time with a national database called the patient demographic service, which is part of the central data spine. All data is recorded against real, unambiguously identified, individuals. "It is quite a cultural change, it forces people to do things properly every time. Staff have to deal immediately with discrepancies such as out of date telephone numbers", Haw says.

Once administrative data are on a sure footing, the NHS can get on with the real challenge - adding medical data to the spine and using it to support doctors' decisions. A couple of obstacles lie along the way. One is a disagreement among doctors about what clinical information should go onto the spine and who should be able to see it.

Another, dramatically illustrated last week, is that centralising technology creates a central risk of failure. Despite supposed state-of-the-art disaster recovery procedures, contractors' data centres serving the NHS in the West Midlands and North West England failed, forcing hospitals like Birmingham to revert to paper-based administration. This is why the West Midlands is no longer quite the showcase that it was.

Nonetheless, Birmingham's progress on the National Programme for IT is far ahead of most of the rest of England; certainly years ahead of London, which has just sacked the firm originally contracted to bring hospitals up to spine compliant standards. The lesson is that for an organisation like the NHS, getting the basic standards right is a long, gruelling and costly slog.

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